- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,467.37 / $5,248.07
| Facility | | $933.25 | $3,467.37 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,801.89 / $6,760.83
| Professional | | $3,162.28 | $3,801.89 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,897.79 / $5,888.44
| Professional | | $4,365.16 | $4,897.79 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $3,235.94 / $3,235.94
| Facility | | $39.81 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $6,025.60
| Facility | | $489.78 | $812.83 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,570.88 / $8,128.31
| Professional | | $2,754.23 | $4,570.88 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,174.90 / $5,754.40
| Facility | | $371.54 | $1,174.90 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,890.45 / $6,606.93
| Professional | | $2,951.21 | $3,890.45 | $6,606.93 |